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A 73-year-old retired analytic chemist presented with 4 weeks of epigastric discomfort, weight loss and loose stools. His medical history revealed pancreatic insufficiency on the background of a pancreatic mass, which had resolved 8 years previously, childhood eczema, and shellfish allergy. Laboratory investigation demonstrated an elevated C-reactive protein of 32 mm/L and IgG of 14.8 g/L with negative endomysial and auto-antibodies, normal blood count, liver function and amylase.
CT of the abdomen showed concentric thickening of the ascending colon and caecal wall with serosal abnormality and mesenteric lymphadenopathy (figure 1A, B). Ileocolonoscopy revealed an oedematous and inflamed proximal ascending colon, caecal valve and terminal ileum (figure 2A–C). The transverse colon, left colon and rectum were spared. Colonic biopsies showed an infiltrate rich in lymphocytes and plasma cells, with no granuloma or dysplasia (figure 3A).
Contributors ELC was responsible for conception, patient consent, drafting and submitting the final manuscript. LMW performed histological assessment and immunostaining of specimens, and provided histology images. HB performed radiological interpretation and provided radiology images. RWC and JC were responsible for patient investigation and management. All authors were members of the IgG4 multidisciplinary team and critically reviewed and approved the final manuscript.
Funding ELC received funding from the Wellcome Trust [095160/Z10/Z].
Competing interests None declared.
Patient consent Obtained.
Ethics approval Oxfordshire Research Ethics Council.
Provenance and peer review Not commissioned; externally peer reviewed.
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